Cooling it gets hot

Conflict is an inevitable part of work and relationships. How it is handled determines what can and cannot be accomplished personally, professionally, and organizationally. The pressures and complexities of health care interactions breeds conflicts that require constant, skillful negotiation. Increasingly, health care leaders are recognizing that proficiency at recognizing sources of friction before trouble flares up and at managing and resolving disputes that do break out is an essential part of their executive "toolbox." Resources are now widely available for acquiring fundamental knowledge of dispute prevention and negotiation techniques, and for locating and engaging reliable expertise when third-party intervention appears necessarily to reconcile apparently intractable differences.     

Instilling a mediation-based conflict resolution culture

Conflict thrives and grows in the increasingly competitive and uncertain health care environment. Conflict impacts health care organizations' performance in several areas: (1) patient grievances and health plan member disputes; (2) internal employee and management disputes; and (3) payer, provider, and vendor disputes. "Grief Budgets," the hard costs and soft costs due to disputes that are poorly handled and conflicts that are ignored, detract from an organizations health mission and erode its bottom line. This article offers a strategy to solve conflict at an early stage in all three areas, with measurable results that strengthen profits and improve customer service by instilling a mediation-based conflict resolution culture throughout the organization. Mediation is non-adversarial, neutral, proactive, and collaborative. It is also confidential and always protects the future relationship between the parties. The challenge, therefore, is to strategically implant mediation into the health care organization's structure, to intercept and solve conflict early on. The article provides an overview of the steps needed to install a dispute resolution program.     

Conflict management, Part 1. Conflict management checklist: a diagnostic tool for assessing conflict in organizations

Complex interpersonal conflicts are inevitable in the high speed, high stakes, pressured work of health care. Poorly managed, conflict saps productivity, erodes trust, and spawns additional disputes. Well managed, conflict can enhance the self-confidence and self-esteem of the parties, build relationships, and engender creative solutions beyond expectations. Just as thoughtful differential diagnosis precedes optimum treatment in the doctor-patient relationship, management of conflict is greatly enhanced when preceded by careful assessment. In the first of two articles, the authors present a diagnostic approach, the Conflict Management Checklist, to increase self-awareness and decrease anxiety around conflict.     

Negotiate the salary you want

How can physician executives negotiate the salary and terms that they want for a new position? The idea of negotiation raises the anxiety level of all but a few people, those who thrive on the thrill of competitive bargaining. Most physicians do not relish the process and view it as a type of conflict. But without knowing what you want to accomplish and preparing to ask for it, you may well leave the meeting frustrated and unhappy with the offer. Determine what you want before you get into an important negotiation. You will get clear on what you want much quicker and you will remember the points better when you talk to the other person.     

The grief involved in change

In this era of rapid change, people need to be helped through the grieving process at work. "By acknowledging and articulating what is involved, you facilitate people's movement through it ... successful people in growing organizations need to learn to move through the process as quickly and efficiently as possible and help others do the same." Morris Shectman, in Working Without a Net says, "Contrary to the old paradigm--which held that others don't have a right to know about your personal life--the new paradigm says that it's a necessity that they know." If people are to move through the grief that is caused by undesired change, they will have to tell some of their personal feelings. "Each stage of the process--shock and denial, anger, bargaining, depression, and acceptance--is functional ... when people go through the process in a healthy manner, they'll recycle through it in a diluted fashion." Leaders in the organization can help people start the process or move through it if they get stuck at a particular stage.     

The coming alliance revolution in health care

Like it or not, the health care profession is being "shifted" into a revolutionary new world. The question is not will it change but rather how will it change? Who will determine its fate? What form will these changes take? What are the best alternatives for physicians, institutions, health care workers, insurers, employers, and, most importantly, patients? Some of the changes will come from government mandate, others from market forces. To understand what the future might bring, we should look at both the driving forces behind the changes and how other industries have responded to similar forces. An important consideration for health care professionals will be how, if at all, the concepts of collaboration and cooperation that are inherent in networking and alliances will guide their planning.     

The Role of Task and Process Conflict in Strategizing

The implementation of strategic initiatives is central to organizational success because it involves not just the execution of strategy, but also the formulation of strategy content. Yet, strategy implementation is complex, partially because it is critically affected by human dynamics. These dynamics are an integral but poorly understood aspect of how organizations negotiate multiple goals. Conflict is one dynamic that has received little attention in the context of strategy implementation. The authors address this gap by studying task and process conflict as a firm implements a strategy in real time. The study demonstrates that process conflict directs attention to problems with how to implement a strategy, while task conflict directs attention to problems with the content of the strategy. Critically, however, managers can only harness generative effects of conflict if they correctly diagnose process and task conflict, and respond to both forms of conflict. This requires an understanding of the entwined nature of task and process conflict, and highlights the necessity of aligning responses to these forms of conflict. Thus, this study offers conflict as one explanatory mechanism of how actors execute strategy and clarify strategy content.     

Part 2, Conflict management. Managing low-to-mid intensity conflict in the health care setting

Physician executives face low to mid-level intensity conflicts, day-to-day issues and problems associated with pressures and changes in the health care environment. Such conflicts can be sorted on the basis of relationship, duration, and intensity. The authors apply the five major modes of conflict management--competition, avoidance, compromise, accommodation, and collaboration--to specific scenarios taken from their work in health care and suggest guidelines for managing conflicts with peers, supervisees, and authority figures. Thorough preparation and a portfolio of skills build flexibility through the conflict management process. In part 1 of this article series, the authors presented the conflict management checklist, a diagnostic tool for assessing conflict in organizations.     

The ascendancy of primary care: permanent or temporary?

The conventional wisdom strongly suggests a health care provider food chain for the future: Primary care physicians (PCPs), principally family practitioners, on the top playing the lead role, distantly followed by specialists, with hospitals and other ancillary services even further down the line. Is this a reasonable expectation? Will PCPs dominate the new systems? Or will they be but one of many equally necessary components of these developing integrated health care delivery organizations? Looking at the various models now developing, it would seem that future integrated delivery systems will utilize both PCPs and specialists, but with strong augmentation from a diverse assortment of other health care professionals, including nonphysician providers, educators, and administrators. To separate the illusion of primary care dominance of the coming health care system from the likely reality, we should first determine what is driving the apparent present demand for primary care physicians. Next, we will examine the possible and probable reactions to that demand from an economic standpoint and from the points of view of both health care professionals and the public. Finally, we must try to picture how health care provider organizations of the future are likely to look and how they will integrate their health care professionals.     

What lies ahead for medical management?

The consensus is that, in spite of a reluctance in Washington to undertake any drastic reform of the health care financing and delivery system, the changes that are already in place in individual organizations and that are in place or being contemplated at the state level are certain to make the health care system of tomorrow very different from that of today. Physician executives can play an important role in the transition that will be required, but they will have to use a flexible, especially nondogmatic approach if they wish to cope successfully in this increasingly whirling environment. For such physicians, the author says, the opportunities, though unknown, are enormous.     

The minds of a medical director

This article is offered in a nod to all those readers who have been exposed to "whole brain" theory, either through the American College of Physician Executives or elsewhere. As managers struggle with balancing the "left brain" and "right brain" aspects of their work, the author says, they might consider exploiting a third area of activity, or inactivity--the "no brain." This center position can be especially effective in dealing with the high-technology aspects of delivering health care.     

Lessons from life. The biology of business transformation

Biology and business face similar challenges when it comes to change. Living organisms experience constant change. And successful health care organizations must be ready and willing to embrace transition if they are to survive. Take an in-depth look at the biology-to-business metaphor and see how to better manage information technology changes in your organization.     

New governance for a new era: issues and challenges for integrating systems

In this second part of a two-part column, Dr. Ruffin provides greater detail on seven key factors that he believes will govern the operations of integrated systems. Successful systems, he says, will be those that attract and retain physicians, have disciplined governance, integrate care through sharing of information among system elements, conserve capital, ensure strategic growth, control costs, and are proficient at processing information. It is important to understand, he says, that, in the movement from a fee-for-service payment mechanism, in which the various elements of the health care field bill for their services independently and according to rules designed for their benefit, to an integrated system, in which such independence can only lead to chaos, very substantial changes will be required in the governance of our health care institutions and organizations.     

Herding stats: the quality measurement dilemma

All over the country, millions of research dollars are being spent to devise an effective way of measuring quality that could be standardized in health care, and hospitals and managed care companies are experimenting with a variety of quality tools, trying to document what they now can only perceive as improvement. Experts are divided on what works best, but all applaud and embrace the efforts. In this special report, several of them discuss their views on what works, and what doesn't work, in the exploding field of health care quality measurement.     

The doctor/patient relationship for the 21st century. Clash of 'cultural creatives' and 'traditionals' helps focus the future of patient care

The doctor/patient relationship is at a crossroads. Some patients--traditionals--want the doctor calling all the shots, deciding the best treatment path to follow. But cultural creatives--heavily influenced by bioethics--desire more of a give and take when it comes to their health care. They see the physician as an advisor, and they want to decide the best treatment on their own terms. Take a close-up look at factors influencing the doctor/patient relationship in the 21st Century.     

Newspapers foretell health care's future.

This article is based on a two-months snapshot (November 1998 to January 1999) of newspaper articles addressing various health care issues. Newspaper contents reflect the changing market share of competing societal concerns. Health care issues, particularly cost and choice, now preoccupy the American people. Health care trends percolate bottom-up through the pages of newspapers, not top-down from Washington, D.C, policymakers, or health care executives. By reviewing these articles, the author provides a big picture view of the prevailing and emerging health care trends. From the new thrust of consumerism and the public backlash against managed care organizations to the demise of HMOs and PPMCs, these observations signify not only the concerns that are bubbling to the surface but also the direction that health care is headed. Consumers are in the driver's seat and physician executives need to provide them with evidence of the value they desire--and understand what they perceive as value.     

Hospital management's linchpin: the medical director.

The practice of medicine has become increasingly complex in this era of diagnosis-related groups (DRGs) and other direct government involvement in health care; complex and seemingly inappropriate legal decisions; liability chaos; and increasing competition from peers, entrepreneurs, and other health care organizations. In this new environment, an old player, the medical director (vice president of medical affairs) has been given new visibility and increased responsibilities to help physicians live with and overcome these environmental factors. In showing how the medical director can be of assistance in putting these factors into perspective, it is helpful to take a look at some aspects of the history of medicine, analyze the education process for physicians, point out where the profession began to be driven off course, and identify some of the overall problems of the profession and of the health care field. It is my intent here to project the position of medical director as a vital, frequently missing, link in the attempt to maximize communications, understanding, and achievement in health care organizations.     

Leading with soul/retaining employees. Authors of new book explore keys to employee satisfaction.

In today's competitive health care market, finding and keeping good employees is important to an organization's success. Take a look at some ways that managers can show an interest in their employees' welfare and help retain highly valued health care workers.     

Conflict management, prevention, and resolution in medical settings

Everything about conflict is difficult for physicians, who are by nature and conditioning quite confrontation adverse. But conflict is inevitable, and conflict management skills are essential life skills for effective people. The keys to conflict management are prevention, effective communication, and anger management, skills that can be learned and polished. Conflict management skills can enhance all aspects of life for physicians, as well as those who work or live with them.     

U.S. health care in conflict--Part II. The challenges of balancing cost quality and access

Faced with the technology explosion, the aging population and the growing uninsured, our health care system confronts an uncertain and troubling future. In this second part of a two-part series, look at some proposed solutions to the problems.